Individual
JASON JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2609 S 10TH AVE STE 102, CALDWELL, ID 83605-6885
(208) 454-2766
Mailing address
702 SUNSET DR, ONTARIO, OR 97914-3121
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
34439
ID
1041C0700X
Clinical Social Worker
Primary
LCSW36510
ID
Other
Enumeration date
02/12/2015
Last updated
04/25/2017
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